The Robert Wood Johnson Foundation ranked Kern County toward the bottom of the state when it comes to health outcomes, but one local health economist says that those rankings are inflated and that the county actually falls in the middle of the pack.
The foundation ranked Kern County 52 out of 57 California counties analyzed for health outcomes, a measure based on a variety of factors, including length and quality of life, health behaviors, social determinants, clinical care access and physical environments.
But when Cal State Bakersfield Assistant Professor of Economics Richard Gearhart analyzed the data, he found Kern ranked about 30th in the state. That’s because the foundation weighs length and quality of life most heavily, but does not account for population health, which is the general health outcomes of certain groups of individuals, Gearhart said. Once that is factored into the equation, the rankings change dramatically.
If a county has a large population of uninsured people who are under-educated, the county may “be doing very well in mitigating the health outcomes in relation to the population they are dealing with,” Gearhart wrote.
“The rankings miss a critical consideration when separated into health factors and health outcomes: that certain counties may be producing healthcare efficiently with a low level of healthcare inputs and can do no better without sizable reform,” Gearhart wrote in an unpublished research paper. It could be that some counties — including Kern — are doing the best they can with what they have, but that the Affordable Care Act didn't do enough to produce long-term impacts for improving health access, Gearhart said.
In Kern County, for example, it’s an uphill battle for health providers. Community health is poor overall. Kern county has high rates of STDs, teenage pregnancy, asthma and stroke. Some health issues are a result of environmental factors largely beyond the public’s control, like air quality.
“We’re not going above and beyond our duty, but we’re starting so far down with our health behaviors, demographics and socioeconomics that our providers are moving us way up. They’re starting with people who have never seen a doctor before and they’re getting them to follow a diet or start exercising or pass behaviors down to children,” Gearhart said.
One of the factors analyzed — health care costs — is artificially driven up by the county’s high teen-birth rates, Gearhart said. Kern’s health care costs hover around $9,800 per person, according to Medicare reimbursement data collected by the foundation — roughly $800 more than the state average. One single pregnancy, however, costs about 75 percent of all health care spending most families plan for in a year, Gearhart said.
“We need to take into account the differences between population health,” Gearhart said. “Kern has a lot of issues.”
Many of the poor health outcomes in the region can be explained away by the types of jobs people here work, Gearhart said.
He pointed to agriculture and oil field jobs, which break down the body at faster rates than those jobs that might be typical in other areas.
While Gearhart is critical of how the foundation collects and weighs data, he said the work is still important because it illustrates “broad brush measures that matter.”